Sedation Flashcards
Oral Midazolam
0.25-1mg/kg; max 15mg
Nasal Midazolam
0.4-0.5mg/kg
10mg max dose
Oral diazepam
0.5mg/kg; 15mg max dose
96hr half life of ACTIVE metabolite
Flumazenil (Nasal)
Vinson’s lecture:
0.01mg/kg
0.1-0.2mg per dose, max 0.1mg in each nostril
Flumazenil MOA
benzodiazepine competitive antagonist
can also reverse binding of benzos to benzo receptor
Flumazenil (IM)
0.01mg/kg IV (max single dose 0.2mg)
Wait 45s, then repeat at 1 minute intervals up to 4 more times
Max total dosage = 1mg or 0.05 mg/kg (whichever is lower)
How long do you monitor patient for after reversing benzo or narcotic OD?
2 hours
BMI formula
weight (lb)/ [(height (in) ^ 2] x 703
i.e. 150lbs, 65in = 24.96 BMI
Ketamine should not be used in combination with _______
Nitrous oxide
Ketamine can cause respiratory depression
Typical Ketamine dose
2-6mg/kg; max 100mg WITH 0.3-0.75 mg/kg midazolam; max 10mg
Why spray/atomized delivery?
Med can be delivered from any position very quickly
Larger surface area compared to drops
Less run-off out of nasal cavity
Describe bioavailability of oral vs nasal meds
Oral: most not bioavailable due to stomach acid destruction, partial absorption by gut, AND first pass metabolism by the liver
Nasal: rapid absorption through nasal mucosa with almost 100% uptake without first pass. Lower dosage than oral because more is absorbed
Clinical reasons to do IN sedation
direct route into bloodstream due to rich vascular plexus of nasal cavity
Nearly immediate delivery to the CSF == CSF absorption can rapidly allow brain and CNS therapy
Olfactory mucosa importance in nasal medications
olfactory mucosa located in upper nasal cavity, below cribiform plate
Meds can transverse olfactory mucosa and enter CSF.
Mucosa has rich, vascular capillary bed
3 routes that drugs go from nasal mucosa to CNS
-olfactory neurons
-capillary beds
-CSF
The only location in the body that provides a direct link to the CNS
Nasal mucosa
What types of drugs are rapidly absorbed across mucous membranes? Lipophilic or hydrophilic?
Lipophilic i.e. midazolam
Contraindication for intranasal medication
Cocaine use
Bloody nose, congestion, mucous discharge
Surgical destruction of nasal mucosa
clef lip/palate repair affecting the nose
Is the highly concentrated form of med preferred for nasal technique?
Yes, we want to minimie volume to reduce runoff
1/4 to 1/3 mL per nostril is ideal, but 0.5-1mL is tolerable
